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Terence Millin (1903 - 1980): Surgeon and medical pioneer

Terence Millin was one of the most outstanding surgeons to come from Ulster, and his reputation in his chosen field was unsurpassed internationally; the pioneering operation, Millin’s prostatectomy, was named for him.

He was born at Sheridan Lodge (later 3 Bridge Street), Helen’s Bay, County Down; his mother was a teacher and headmistress, his father a barrister and local historian who thoroughly chronicled the Non-Subscribing Presbyterian Church of Ireland and was honorary Librarian of the Statistical and Social Inquiry Society of Ireland. In 1907 the family moved (for reasons which are not clear) to Dublin, where Terence Millin was educated at St Andrew’s School (then in St Stephen’s Green) though including two years at the Abbey School, Tipperary. His school record was outstanding, both academically and on the sports field, winning almost every medal available in both areas. He entered the University of Dublin in 1921, initially to read mathematics (he won one of the two foundation scholarships in that discipline, and did so in his first year, an almost unheard-of achievement) and later medicine, where he was placed first in each of his undergraduate years and won every prize and scholarship for which he was eligible. He maintained his sporting interest, especially rugby. He played for the University team which soundly trounced the then-rated first top British Isles university team of Oxford – on their home ground - and was capped (made an international appearance) for Ireland in 1925, when Wales were his and his team’s victims, Millin scoring the first try within three minutes of kick-off.

Millin qualified in 1927 and was appointed “honorary assistant surgeon” (more informally, house surgeon) at Sir Patrick Dun’s Hospital, Dublin, which he knew well having trained there as a clinical student. Within one year of his graduation, he achieved the remarkable feat of taking the London “Conjoint” (Member of the Royal College of Surgeons and Licentiate of the Royal College of Physicians) as well as completing the Fellowship of the Royal College of Surgeons in Ireland. With the aid of a Travelling Scholarship from Dublin University, he moved to London, to the Middlesex Hospital and Guy’s, and subsequently All Saints’ Hospital, Pimlico and the Royal National Orthopaedic Hospital, Great Portland Street. It was at Pimlico, an entirely urological institution, that he encountered its founder and proprietor, Edward Canny Ryall, also a Dublin graduate. In 1930 he was admitted Fellow of the Royal College of Surgeons and in 1931 he took first place in the Dublin University MCh examination. One constituent element of this examination was in an optional subject from an approved list; Millin opted for genito-urinary surgery, which would become his life’s work and achievement.

He began his career as a practitioner in London but in that competitive environment he was at an immediate disadvantage as an outsider at several levels, but Ryan, who had become something of a mentor to Million, died on 11 February 1934, Millin inheriting his position at all Saints, Pimlico, as well as much of his practice including premises at 75 Harley Street. Millin was thus well placed to apply his talents, energy and determination to the area of urology. During the 1930s and 1940s, he secured number of part-time appointments as urologist or genito-urinary surgeon, giving him access to more and more beds, while a busy attender at professional meetings and keeping himself thoroughly apprised of all the relevant professional literature. During the Second World War he served in the Emergency Medical Service as a surgeon in Putney Hospital.

On 1 December 1945 The Lancet published what was immediately recognised as a highly significant paper by Millin, entitled “Retropubic Prostatectomy. A new extravesical technique. Report on twenty cases.” In just three pages Millin outlined what he regarded as a “better way” relating to prostatectomy, the then favoured techniques being the “closed prostatectomy” and the “open prostatectomy”, both of which he found unsatisfactory for reason of having to remove the prostate through another organ (for “open” operations) or using unsatisfactory instruments (for “closed” operations). Succinctly, Millin’s method involved removing the prostate by direct incision in the abdomen into the retropubic space, known as “Retzius’ Space”, which had up to then been avoided by surgeons due to high infection risks. Millin combated these risks with the use of sulphonamides, which were then becoming more and more effective. He first (publicly) demonstrated his new operating procedure in October 1945, to the Association Française d'Urologie (the French Urological Society) in Paris.

The recognition that this was a highly significant surgical innovation was so immediate that the procedure was lauded in an editorial in the very same issue of The Lancet, whose authorship was anonymous according to editorial policy, though it was widely believed that it had been written by Sir Heneage Ogilvie, senior surgeon at Guy’s Hospital. To underline the Journal’s welcome for Millin’s achievement the editorial was entitled quite simply, “Eureka!” The operation had something for everyone, it seemed; the writer stated (this evidently aimed at the surgeon): “Millin’s new operation seems to avoid the dangers and discomforts of the transvesical approach and the sequelae of the perurethral operations”, then adding for patients that they should be “loudest in their approval for they are relived from one of the most distressing afflictions known to man, by an operation that involves scarcely more pain and no longer convalescence than an interval appedicectomy.” Two years later, Millin published a 200-page book, Retropubic Urinary Surgery, which contained further observations on prostatectomies and other surgical procedures.

All this made Millin something of a legend among surgeons as well as patients, the latter of whom provided the fees which in turn provided Millin with imposing premises, a chauffeur-driven Buick, and for good measure a Cadillac for his wife. However, by 1950, the cracking pace of his surgical work combined with his being in great demand as a lecturer and demonstrator prompted him to look for a more relaxed pace of life and he decided to move back across the Irish Sea. He acquired a 150-acre estate, “Byblox”, near Cork, where there was also a convenient ferry – he certainly had not abandoned his London activities altogether. In 1961 he moved to a spacious property in County Wicklow, and would later reside at Enniskerry and Kilcoole. He declined clinical practice in Ireland, instead dedicating himself to the affairs of the Royal College of Surgeons in Ireland including three years as President.

Within the medical profession Millin received numerous honours from all over the world: the list is long, and included, for example, honorary memberships of the Urological Associations of France, Belgium, the USA, Italy, Romania and Turkey; a number of prizes and medals came his way as did invitations to deliver distinguished lectures. The Millin Room in the RCSI was named for him. However, he received no honorary degree, and the medical school in his native Ulster did not even acquire a copy of his world-renowned and groundbreaking book. He did though receive very positive obituaries, and was biographised in 2002.

Those knew him spoke well of him and in many ways. He was apparently modest, though he enjoyed the fine lifestyle his fortune afforded him. He was universally admired in the profession not least for skill at the operating table at time when these were unventilated and whose lighting produced more heat than light. To work with or under, his biographer wrote: “He could disagree without being disagreeable.” Summing up his achievements, the Urologist-in-Chief of Johns Hopkins Hospital stated: “Every surgeon who has laboured in the field of radical retropubic prostatectomy in an attempt to improve the procedure has to stand on the shoulders of Terence Millin.”